Healthcare Provider Details

I. General information

NPI: 1871942557
Provider Name (Legal Business Name): MELISSA MCCORMICK FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/03/2016
Last Update Date: 12/12/2025
Certification Date: 12/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1800 COBURG RD
EUGENE OR
97401-4995
US

IV. Provider business mailing address

508 HIGH ST
MOUNT HOLLY NJ
08060-1052
US

V. Phone/Fax

Practice location:
  • Phone: 541-345-8760
  • Fax:
Mailing address:
  • Phone: 866-389-2727
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number26NJ00680300
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number10026208
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: